Healthcare Provider Details

I. General information

NPI: 1396473567
Provider Name (Legal Business Name): BRIGHT BEHAVIOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 05/13/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23500 PARK ST STE 3
DEARBORN MI
48124-2598
US

IV. Provider business mailing address

27247 KINGSWOOD DR
DEARBORN HEIGHTS MI
48127-3361
US

V. Phone/Fax

Practice location:
  • Phone: 313-645-2422
  • Fax:
Mailing address:
  • Phone: 313-645-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SONIA SALMAN
Title or Position: MANAGER
Credential:
Phone: 313-645-2422